Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia.
Department of Nursing, College of Health Sciences, Salale University, Fitche, Ethiopia.
PLoS One. 2023 Feb 16;18(2):e0279167. doi: 10.1371/journal.pone.0279167. eCollection 2023.
In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.
Data from 2019 Ethiopian demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.
A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR = 1.8: 95% CI: 1.44-2.26), secondary education (OR = 3.65: 95% CI: 2.19-6.1), diploma and higher (OR = 2.74: 95% CI: 1.02-7.34), women who had both Radio and Television were 4.6 times (OR = 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR = 2.72, 95% CI:2.2, 3.34), rich wealth index (OR = 2.22; 95% CI: 1.62-2.99), birth interval for 18 to 33 months (OR = 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR = 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR = 4.68; 95% CI: 4.13-5.30), and Region were associated with institutional delivery.
A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions. A preprint has previously been published.
在埃塞俄比亚，尽管在改善母婴健康方面取得了进展，但仍有大量产妇在医疗机构分娩（26%），这导致了大量产妇死亡（每 10 万例活产 412 例死亡）。因此，本研究旨在确定在埃塞俄比亚，在调查前五年内有活产的妇女在机构分娩的空间模式和影响因素。
本研究使用了 2019 年埃塞俄比亚人口与健康调查的数据。考虑到数据的嵌套结构，采用多水平逻辑回归分析对全国具有代表性的 5753 名妇女进行了分析，这些妇女嵌套在 305 个社区/群中。
在机构分娩方面，各社区之间存在显著的异质性，这解释了总变异的 57%。个体水平变量：小学教育（OR = 1.8：95%CI：1.44-2.26）、中学教育（OR = 3.65：95%CI：2.19-6.1）、中专及以上学历（OR = 2.74：95%CI：1.02-7.34）、同时拥有收音机和电视机的妇女是 4.6 倍（OR = 4.6；95%CI：2.52，8.45）、有 4 次及以上产前检查（AOR = 2.72，95%CI：2.2，3.34）、富裕的财富指数（OR = 2.22；95%CI：1.62-2.99）、18-33 个月的生育间隔（OR = 1.8；95%CI：1.19，2.92）和间隔 33 个月及以上生育的妇女（OR = 2.02；95%CI：1.3，3.12）与机构分娩有关。社区水平变量，社区产前检查比例高（OR = 4.68；95%CI：4.13-5.30）和地区与机构分娩有关。
在埃塞俄比亚，观察到了地区机构分娩率低的聚类模式。个体和社区水平的因素都与机构分娩显著相关，这表明需要通过卫生推广计划和社区卫生工作者对社区妇女进行教育。为了促进机构分娩，应特别关注产前保健、教育程度较低的妇女以及考虑到服务的意识、获取途径和可及性的干预措施，这对各地区都是至关重要的。
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